October 1999 Bulletin

Musculoskeletal conditions in the U.S.

Academy publication documents huge impact on society

Millions of Americans-young and old, sturdy and frail-are
afflicted with musculoskeletal conditions that limit their productivity,
distract them with pain, rob some of their independent living
and cost the economy billions of dollars each year.

The impact on the quality of life and the nation
is so huge that it's difficult to grasp.

Musculoskeletal conditions and injuries are usually viewed individually-arthritis,
osteoporosis, back sprain. They are often accepted stoically as
the consequence of aging or just another hazard of the workplace.
Because musculoskeletal conditions are generally not fatal, they
don't get the same attention from policymakers and the media as
other "deadly" diseases. When musculoskeletal conditions
and injuries are reckoned in the aggregate-in terms of people,
costs, health care resources-the impact on society and the nation
is staggering.

The full dimensions are disclosed in the Academy's just-published
Musculoskeletal Conditions in the U.S. (second edition).
It's a comprehensive, up-to-date view of the impact on the well
being of Americans, the health care system and the economy. Using
the latest available statistics and expert analysis, the Academy's
department of research and scientific affairs documents the significance
of musculoskeletal diseases and injuries.

Musculoskeletal conditions cost the United States economy more
than $215 billion a year. Arthritis and other rheumatic conditions,
alone, have an annual economic impact on the nation roughly equivalent
to a moderate recession, with an total cost of about 1.1 percent
of the gross national product, says Edward H. Yelin, PhD, professor
of medicine and health policy, University of California, San Francisco.

There's the human toll, too. One in every 7 Americans, or 36.4
million people, have a musculoskeletal impairment that limits
or decreases their ability to function at home, work or at play.

Musculoskeletal impairments are a leading cause of restricting
a person's activity or confinement to bed and a leading cause
of work loss.

The impact of musculoskeletal conditions and injuries is expected
to grow as the population increases and ages in the coming decades.
That's also true in other countries. The United States and nations
around the world are raising awareness of the societal burden
of musculoskeletal conditions and the need for research in an
international effort, the Bone and Joint Decade 2000-2010. (See
story on page 37.)

The need to make the case for musculoskeletal conditions as a
target for research funding is critical in an era when there is
great competition for limited funding. Although musculoskeletal
conditions cost the economy more than $215 billion a year, only
$92 million is devoted to orthopaedic research and of that, $15
million is for clinical research.

"Musculoskeletal Conditions in the U.S. provides the most
complete and current documentation concerning musculoskeletal
diseases and injuries, including arthritis, back pain, bone and
joint injuries and developmental disorders in children,"
says Joseph A. Buckwalter, chairman of the Academy's Council on
Research and Scientific Affairs. "It will help direct future
efforts to improve prevention and treatment of these conditions
through research and improved diagnosis and treatment."

Here are some highlights.

Arthritis

Arthritis affects more than 32 million Americans
or almost 1 out of 8 Americans. It is reported by almost 50 percent
of people age 65 and older.

Although some significant research holds out hope for new treatments,
until they come into use, the demographics of an aging population
indicate that by 2020 an estimated 60 million Americans, or more
than 18 percent of the population, will be affected by arthritis.

Today, arthritis is the leading cause of disability. It is a more
frequent cause of limitation of activity than heart disease, cancer
or diabetes. It is second to heart disease in causing work disability.

Arthritis is the second most frequently reported chronic condition.
Among females, arthritis ranks second to chronic sinusitis; among
men it ranks fifth, following chronic sinusitis, deformities or
orthopaedic impairments, hearing impairments and hypertension.

The condition accounts for 39 million visits to physicians and
more than 500,000 hospitalizations.

The total of arthritis is more than $82 billion.

Osteoporosis

In the last few years, public education campaigns
have been launched to encourage increased consumption of calcium
to prevent osteoporosis and for good reason. Osteoporosis affects
25 million Americans, 80 percent of whom are women.

Every year, almost 1.3 million fractures are attributed to osteoporosis-about
250,000 are hip fractures; 250,000, wrist fractures; and 500,000
vertebral fractures.

The cost of treating these fractures was estimated to be $13.8
billion in 1995 and is expected to double in the next 50 years
unless prevention and treatment strategies are initiated. The
Academy is developing a public education program on osteoporosis
as well as a program aimed at encouraging orthopaedic surgeons
to be aware of the diagnostic and treatment strategies for the
bone disease.

Hip fractures are the most serious consequence of osteoporosis
and are more likely to lead to functional impairments than other
serious medical conditions, including heart attack, stroke and
cancer. Two-thirds of the people who fracture a hip do not return
to their prefracture level of functioning.

About 1 of every 6 white women will have a hip fracture in their
lifetime. Hip fracture rates increase exponentially with increasing
age so that beginning at age 65, the rates double for men and
women in each decade of their life.

Arthroplasty

Knee procedures were a key factor in a 22 percent
increase in arthroplasties in the 1990s. An average of 648,000
arthroplasties were performed annually from 1993 through 1995
in short-term general hospitals, compared to average of 531,000
in the 1985-1988 period. Knee procedures accounted for almost
half-47 percent-of procedures. In the 1985-1988 period, knee procedures
accounted for 35.8 percent of procedures.

In 1996, almost 74 percent of total knee replacements and 68 percent
of total hip replacements were performed on patients who were
age 65 and older.

As the population increases and ages, it is estimated that total
knee replacements will increase 85 percent from 245,000 in 1996
to 454,000 by 2030. Total hip replacements will increase almost
80 percent from 138,000 to 248,000 in the same period.

Back pain

It's hardly news to most people, but now it is documented:
75 percent to 85 percent of all people will experience some form
of back pain during their lifetime.

About 1 percent of the United States population is chronically
disabled because of back pain and an additional 1 percent is temporarily
disabled. Two percent of the United States work force has compensable
back injuries each year.

From 1993 through 1995, conditions related to back pain accounted
for more hospitalizations than any other musculoskeletal condition.
Conditions related to back pain, including back injuries resulted
in an annual average of 524,000 hospitalizations a year.

Almost 16.2 million office visits resulted from back pain conditions;
nondisc-related disorders accounted for almost 45 percent of the
office visits. Disc disorders accounted for more than half of
hospitalizations for conditions related to back pain.

Injuries

About 37 million musculoskeletal injuries are reported
annually. Slightly more than half result in limitation of activity
and 20 percent, bed confinement.

From 1993 through 1995, almost 1.3 million hospitalizations occurred
annually for all types of musculoskeletal injuries. Fractures
were the leading injury requiring inpatient services, and accounted
for almost 72 percent of the hospitalizations. Sprains and strains
were second. However, strains and sprains injuries accounted for
16.1 million physician visits, while fractures resulted in 9.4
million visits.

Utilization

Musculoskeletal conditions and injuries place great
demands on the health care system. Three million inpatient procedures
were performed in short-stay hospitals for musculoskeletal conditions
in 1995, accounting for 11 percent of all procedures. About 3.3
million ambulatory surgery visits were made to hospital outpatient
facilities and free standing ambulatory surgical centers. More
than 4.3 million surgical procedures were provided.

Musculoskeletal conditions accounted for almost 131 million visits
to physicians' offices, hospital outpatient departments and hospital
emergency rooms. Of 99 million visits to physicians' offices,
40 million were new problem visits.

Musculoskeletal Conditions in the United States is available for
$50 for members and $80 for nonmembers by calling the Academy's
customer service department (800) 626-6726.